Student Chapter Membership List

To: The Chief Operating Officer of the Association for Computing Machinery

We the undersigned, who are Members in good standing of the Association for Computing Machinery (ACM) or of an ACM Professional Chapter, do hereby submit a request for recognition of the undersigned as charter members of the __________________________ Chapter of the ACM to serve members in the (definition of Chapter area). We request recognition and approval as an official Chapter. Interim officers are as noted below:

Member Number         Please Type or Print Name                        Signature


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Chapter officers and addresses should be indicated; all officers must be Members of the ACM.


This Membership List and bylaws should be submitted to:

ACM
Local Activities Department
2 Penn Plaza, Suite 701
New York NY 10121-0701

Local Activities

Applications for membership and payment of dues may be submitted concurrently.